Health-care mandate will move forward

Funds shortage may limit free, subsidized care

The election results put an end to the threat of a Republican repeal of the health-care law but not to the publics emotional response to it.

Fueled by contradictory campaign claims, the publics reaction ranges widely. Many Republicans fear interference with their medical care, while many Democrats are jubilant that everyone will be able to obtain health insurance for the first time, some with a subsidized price or even free.

But many people remain utterly confused about what the law will change.

Fifty-one percent of Colorado voters chose Obama  even though 55 percent of Coloradans surveyed in exit polls said they favored repeal of the health-care law, according to the Colorado Health Institute.

Experts say the new rules will come quickly to allow full implementation of the law in just 14 months, and that will help sort out whats real and what needs fixing.

Up to half a million Coloradans are expected to obtain health insurance as a result of the law.

According to the Kaiser Family Foundation, the changes by 2014 include:

Insurance companies wont be able to refuse anyone coverage. Rejection for pre-existing conditions and age will be barred.

Families of four with incomes up to about $100,000 can expect tax credits to reduce the cost of insurance.

Most people will be required to buy insurance. Religious exemptions will be allowed.

The tax for refusing to buy insurance starts at $95 a year and rises to $695 or 2.5 percent of income.

Insurance rates will drop for older people and rise for younger people.

Employers of 50 or more full-time staff will have to provide health insurance or pay a tax.

Tobacco users can be charged extra for health insurance.

Already:

Employers with 25 workers or less may be eligible for tax credits.

Insurance price increases are limited. Charges for executive salaries and administration are limited. Insurance companies that violated these rules have paid millions of dollars in refunds to customers.

People like Dr. William Plested, a former president of the American Medical Association who retired to Bayfield in Southwest Colorado, have issued dire warnings that the law will make cost containment more important than the best treatment for the patient. Plested expects a deluge of new rules in the coming months that will prove him correct.

Some people at Colorado rallies for Republican candidate Mitt Romney said they expect outright rationing of health care because of high costs.

But Alfred Gilchrist, CEO of the Colorado Medical Society, says physicians will speak up if any of that shows up.

To the extent that the law is impacting patient care, were going to be hearing about it, Gilchrist said, and the CMS will pass physician concerns onto lawmakers and the Obama Administration  whether the impact is positive or negative.

Very few laws are ever written perfectly, he said.

One state legislator is a physician herself, Sen. Irene Aguilar, a Democrat from Denver. She hopes for an open and honest and mature discussion about health care now that the election is over.

And the people who know how to save money and deliver good care are the physicians, so she hopes to see them have greater influence in implementation.

But theres much left uncertain, largely because of funding shortages at the state and federal level. Most important, some 200,000 Coloradans may  or may not  gain free health insurance by being added to Medicaid, the government insurance program for low-income Americans.

The law raises the income limit for Medicaid for a single person to about $16,000, just above a full-time minimum wage.

Michele Lueck of the Colorado Health Institute said the people who would benefit include the worker who you see each morning when you buy your coffee, the bagger at your grocery store, the server who made your sandwich today, the clerk at the dry cleaning counter.

Lueck said the Colorado Legislature will debate in January whether to accept federal funding to insure those people from 2014 to 2016. The state may have no costs for this, except for administration. But Lueck warned the funding might be reduced in federal budget negotiations.

Starting in 2017, Colorados cash-strapped government must start paying a small percentage of the insurance cost for these 200,000 people, and that adds up into hundreds of millions of dollars. Colorados willingness to pay is in doubt.

The election also switched control of the Colorado House of Representatives from Republican to Democratic. That puts Democrats in charge of both houses and the governors office. Aguilar said she thinks Democrats will be more interested than the very skeptical Republicans in taking federal funds to cover more people with health insurance.

Democrats are more aligned with the idea that we pay for health care one way or another  we pay for it now, or pay for it later with complications, Aguilar said.

Gov. John Hickenlooper, a Democrat, hasnt announced his position.

But the Colorado Hospital Association strongly supports Medicaid expansion, said spokesman Julian Kesner. Thats because it would provide coverage to many people and allow hospitals to reduce their $1.4 billion annual cost of care for people who dont have insurance or dont have enough insurance, he said.